Ambulance Chasteners

Firefighters and medics in the rural east Valley community of Apache Junction want to get their patients to the hospital in a hurry. So when the local ambulance company is slow to respond, the firefighters transport the patients themselves.

But now the state has told Apache Junction to knock it off, saying the fire department isn't licensed to run an ambulance service.

In what's perhaps the most visible uprising of local cities unhappy over slow ambulance service, Apache Junction plans to apply for the state certification needed to form its own ambulance company. Meanwhile, Southwest Ambulance--an arm of the huge Rural/Metro Corporation that has that market locked up--is threatening to take the fire department to court. Southwest wants thousands of dollars in lost revenue and legal fees it says the fire department has cost the company.

More and more, people in outlying areas of the Valley are outraged and frustrated over what they believe are extreme delays in Southwest ambulances arriving at emergency scenes.

Two years ago, Virgil Strait, a retired mechanic, watched his 37-year-old son, Josh, die of a heart attack in their Apache Junction home.

The fire department got there within a few minutes. But Strait says the Southwest Ambulance crew got lost and arrived late.

"I was frustrated--I had a lot of concern about my son," says the 67-year-old Strait.

It's not clear whether Josh would have lived if the ambulance were on time. But after that incident, the Apache Junction Fire Department decided to spend $30,000 on two new rescue trucks so firefighters could transport patients to the hospital themselves.

Firefighters and paramedics elsewhere also complain of slow response times by Southwest Ambulance. As a result, they, too, are clamoring to create their own ambulance services. But they continue to believe the company will do whatever it can to monopolize business in outlying areas of the Valley in its pursuit of profits.

The Bureau of Emergency Medical Services, part of the Arizona Department of Health Services, requires ambulances in the Valley to respond to Code 3 medical emergencies, such as heart attacks and strokes, within 10 minutes. Ambulances are required to be at the scene within 20 minutes for all emergency calls. State regulations allow a 1 percent margin of error, measured over a year's time. That means that the ambulance is supposed to be on time in 9 out of 10 cases.

But it's that one time that firefighters say can make the difference. Says Apache Junction Fire Captain Paul Gomez, "How would you feel if that were your daughter or son, representing that 1 percent?"

Gomez is one of those who feels like David going up against Goliath, because in many outlying areas of the Valley, Southwest Ambulance is the only game in town. It has contracts for most cities in Maricopa County, except Phoenix, where the Phoenix Fire Department runs its own ambulances. Southwest also serves Pinal County, which includes Apache Junction, and Graham County. On any given day, the company has roughly 60 ambulances in service.

Three years ago, the near monopoly in the local ambulance industry was solidified when Southwest merged with the multinational Rural/Metro Corporation. These days, the only competition comes from Professional Medical Transport; but with only 12 ambulances, PMT is considered a blip on the ambulance service radar screen.

For Southwest Ambulance, it's certainly a lucrative enterprise. The company charges $359.77 as its base rate to transport a patient in its Advanced Life Support (ALS) unit. For Basic Life Support (BLS), not as serious a classification, Southwest charges a little less, $335.39. Add to that about $5.50 per mile and the fees can easily top $400 for just one trip to the hospital.

Southwest says 95 percent of its business comes from non-emergency transfers, such as taking a patient from a nursing home to a clinic for tests. But it insists those transfers don't get in the way of responding to emergencies.

Roy Ryals is Southwest's director of emergency services and a paramedic himself. He says delayed response times are "few and far between," a claim the state EMS Bureau agrees with.

But critics contend that the state gives most of the weight to the records supplied by the ambulance company itself, not to the information supplied by the person making the complaint.

Some cities like Apache Junction are making such complaints, saying that patient care is being compromised. Apache Junction fire officials cite several recent cases in which they say Southwest took too long to get to an emergency scene:

* On January 25, a fire crew ended up taking a possible stroke patient to Valley Lutheran Hospital when a Southwest Ambulance failed to arrive after 15 minutes--five minutes longer than the required response time. A Southwest Ambulance had been dispatched from Greenfield and Main, a station about 20 minutes away from the emergency scene.

* On April 15, Southwest took more than 20 minutes--twice the required response time--to get to a patient suffering from a potentially deadly allergic reaction. The location was a home on one of the city's main thoroughfares, but the Southwest crew said it needed a map to find the trailer park, according to fire department reports.

* On April 22, Southwest took 17 minutes, 20 seconds to respond to a Code 3 call for two teenagers thought to have overdosed on drugs. Again, a 10-minute response is required.

Fire crews that respond to medical emergencies in Apache Junction are staffed by at least one paramedic and an emergency medical technician. It's their duty to provide emergency treatment until the Southwest Ambulance arrives.

Southwest says that it's required to respond 90 percent of the time in 10 minutes or less. "Are we going to have 15-minute response times?" says Southwest spokesman Jim Hayden. "Yes. That's why it's not perfection."

But the population boom in Apache Junction could mean the situation will get worse. More and more people are being lured to the far east Valley city, tempted by lower housing costs, new golf courses in nearby Gold Canyon, and closer access to popular recreation areas. Also, a large number of elderly snowbirds, who are more likely to have medical complaints, live in the city's numerous mobile-home and RV parks.

Apache Junction Fire Department officials insist that part of the problem is that the two full-time ambulances provided by Southwest are not enough. The department recently applied for a state certificate to operate its own ambulance service, and to add at least one more rescue vehicle to the district.

The department also wants to keep an estimated $1.2 million in annual revenue that Southwest now gets for transporting patients in Apache Junction. "Those monies don't come back to Apache Junction whatsoever," says Apache Junction Battalion Chief Jim Morgan. "They go back to a corporation in another city, so it does nothing to improve service delivery here."

Southwest maintains there is nothing wrong with its service delivery, and state EMS Bureau Director Stephen Hise agrees that Southwest is in "substantial compliance."

"I would expect absolutely anybody to fall short of the mark, if the mark is 100 percent," Hise says. "What's important is that there is some oversight of that system to make sure they're not falling short for reasons that are predictable and preventable."

But Apache Junction isn't the only fire department that's concerned with Southwest's service. Gilbert also wants to run its own ambulance service because of what it feels are inadequate response times by Southwest Ambulance.

In Sun City, Ken Swick, who heads the fire department's emergency medical services, complains about his city's particular situation, saying, "We have no one else to turn to."

He says the Rural/Metro-Southwest merger three years ago created a monopoly in ambulance service for Sun City. The result: The city had to make "quite a few concessions" in its most recent contract.

"In years past, we were always able to pit Rural/Metro against Southwest," he says. "Now that they've let them merge, there's no competition." As a result, Sun City has had to agree to the standard 10-minute response time for Code 3 calls; previously, the city had an eight-minute response time.

Glendale EMS Fire Chief Mike White also believes that Southwest is ruled by its profit margin. Asked about Southwest Ambulance's response times in his west Valley city, he says they're "getting better."

White says Southwest provided Glendale with more ambulances, but only because the city convinced the company it could make more money that way.

The state Auditor General's Office, in an audit commissioned by the Arizona Legislature, recently concluded that the state needs to change how it regulates ambulance services. The audit said that the current certification system "limits competition in the ambulance industry," creating "a barrier to other service providers wishing to enter the market."

The audit cites as an example Yuma's fire department, which eventually gave up applying for a certificate, citing the existing provider's opposition, the long and legally expensive application process and an overall lack of support from the state EMS bureau.

The audit also blasts the certification system for how it monitors ambulance response times. It's critical of the fact that ambulance companies are the ones solely responsible for submitting response times. It also accuses the state EMS Bureau of not consistently conducting analysis of the data.

But the Bureau's Stephen Hise says his agency is now working on an electronic ambulance reporting system, by which paramedics could use laptop computers to download response-time data to the state every month.

Meanwhile, Southwest Ambulance is turning up the heat on Apache Junction, demanding that the fire department reimburse more than $8,000 that Southwest says it's owed for lost revenue and legal fees for nine transports between November 1998 and February 1999.

The state Department of Health Services has also slapped Apache Junction with a cease and desist order because the fire department persists in taking people to the hospital. In effect, the state says, it's running its own unlicensed ambulance service. While the fire district appeals that order, it has already transported several patients to the hospital, claiming it had no choice because Southwest was running late.

Even though the department still plans to apply for the necessary certification to run its own ambulance service by the end of the year, paramedics and firefighters like Morgan and Gomez expect resistance from a state system that looks unfavorably upon competition--and that favors Southwest and Rural/Metro.

"They [Southwest] basically have a monopoly out here," Gomez says. "They're going to hinder us because they have the entire Pinal County area. I don't think that's right. I think the entire process is very restrictive.


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